HomeMy WebLinkAboutBLDG-22-002584 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH MA DATE November04,202-PERMIT# BLDG-22-002584
JOBSITE ADDRESS 114 CENTER ST OWNERS NAME Denise Delaney
G OWNER ADDRESS TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO❑
FIXTURES FLOORS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE 1
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
OTHER DESCRIPTION:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY❑ BOND ❑
OWNERS INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General
Laws,and that my signature on this permit application waives this requirement.
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will he in compliance with all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Spencer Hallett LICENSE# 16224 SIGNATURE
MP El MGF❑JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑A LLC❑#
COMPANY NAME SPENCER HALLETT ADDRESS, 381 Old Falmouth Rd Unit 36,
CITY MARSTONS MLS STATE MA ZIP 026481372 TEL
FAX CELL EMAIL spencerRhallettplumbing.com
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
MA7:1*.,-077. ': --t.:1--- - 7_ 01
DATE PERMIT CITY __N t„ Trio
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JOBSITE ADDRESS LITT-4 ch6}- OWNER'S NAME
G ..-.�._._._�. LE _ ___________ ___ ,
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.»...... - ........:.__'.OWNER OWNER ADDRESS ( ��,or _,_ ___,. , .___, _____..._ ____ ____
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TYPE OR OCCUPANCY TYPE COMMERCIAL[1 EDUCATIONAL 0 RESIDENTIAL
PRINT
CLEARLY NEW: ri RENOVATION: I 1 REPLACEMENT: j PLANS SUBMITTED: YES ri NO
APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER ....._ --,.I .T,.,, 1I.___.:..___, ,,..__._,.__1I ,_ ___.__�_r._,_.. . ,___AI_ .„„__IL.. ._._ _...,_,K
CONVERSION BURNER
COOK STOVE I _.._ _. . ____. _ ._...._. l? .. .-
DIRECT VENT HEATER .. . .III _ .. _... _.. .
11
DRYER IIIIIIIIIf ( lIM
FIREPLACE
b I I .. , _ . , ,.., _FRYOLATOR _ 111
FURNACE um amil E. NIN MN NM INN MIN NMI NM EN NMI
.,_..,
GENERATOR .,I '' _____
GRILLE
INFRARED HEATER I i _ -0- _ . _ . - - - �--
LABORATORY COCKS { „,_ „.__
MAKEUP AIR UNIT - - - r --- - -— --- - —. -. . - ---il . .- --- _II__ _i_l__ .1,,_ _l__- -11_,----i
OVEN . .. _
POOL HEATER
ROOM / SPACE HEATER
iimmigailiummmon .
ROOF TOP UNIT
i
TEST ! . i - , T
UNIT HEATER , I a .I J[..,_. ..
UNVENTED ROOM HEATER
WATER HEATER I_ _,,,._. .,...�_ .._,; _ t. . _. ..p.__ ...1-. �.__
OTHER �_. ; _ - �_ �,_ �.. ._ _ ...
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Ej NO 0
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [ . OTHER TYPE INDEMNITY [ BOND L_I
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER FTI AGENT E,
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true .•. accurate • - - •est of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in com. %- - VV'4=rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i #;
PLUMBER-GASFITTER NAME Spencer Hallett J LICENSE #[16224 SIGNATURE
MP I ''-,1 MGF ® JP JGF il LPGI 7 CORPORATION }# 3834 1 PARTNERSHIP[ # LLC # __ ...,.,.
COMPANY NAME: Spencer Hallett Plumbing & Heating, Inc. ADDRESS 381 Old Falmouth rd, Suite 36 I
CITY Marstons Mills I STATE MA ZIP 02648 ITEL 508-428-6080
FAX 508-428-7991 I CELL , EMAIL sue@hallettplumbing,com I
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